“This article explores some of the difficulties practitioners experience in POD training and the considerations management need to apply.”
I was on the first tranche of NHS Peer Supported Open Dialogue training 4 years ago and things have evolved tremendously since then. The APOD Board which is the official governing body for all NHS POD training met recently in London to examine progress in the UK and the next step. We discussed the development that is occurring in relation to the RCT's and the various teams that are being set up in a variety of Trusts.
This discussion was also tinged with sadness as we contemplated how many of the Trusts that had been initially involved and extremely enthusiastic in relation to the training have been forced for a number of reasons to pull out. One of the initial teams from North Essex has the whole structure of EIS dismantled and their team disbanded having to interview for posts in other teams. Other team such as Nottingham were effected by cuts and changes in key staff therefore the impetus was lost. Somerset and Avon who have a reputation for being well trained and supported in family interventions were forced after completing the training to pull out due to changes in their Trust's priorities. This applies to other Trust's as well and one wonders why training has been provided to staff and paid for when there has been the possibility of a change of direction and to me this indicates the reactive management of services and the lack of cohesive planning within mental health. This in addition to wasting public money sets up a dynamic that leads to staff dissatisfaction and despondency. If you have emotionally and academically invested in Open Dialogue which is more that an intervention but a concept and way of life you do not wish to return to treatment as usual. The open dialogue training also highlights the inadequacies and brutalities of the current system and leaves one with a desire to reform and change the system. Peer supported open dialogue training can only be implemented and sustained in a peer supported open dialogue team, as Jaakko Seikkula has stated it is a team approach and a way of being. The peer supported open dialogue team sustains and supports the workers in providing open dialogue and through training and ongoing professional development the team evolves and grows.
We in Kent have been fortunate in that senior management was involved from the onset and participated in the training and this management structure has remained unaltered and continues to fight for and advocate open dialogue as an approach. The Kent model is the first and currently the only standalone open dialogue team and the process of setting up such a team in the current setting of mental health services has been extremely difficult. The manager of this team Yasmin Ishaq has fought long and hard for this approach and she was one of the initial advocates. There have however been numerous difficulties in relation to where the team sits and how it interacts with other teams such as EIS and the Crisis Team.
It saddens me that Peer Supported Open Dialogue which commenced life in Western Lapland as an intervention for psychosis is not sitting with and embedded in EIS which is the service in which I work. Unfortunately NHS England has laid down some very rigid strictures for EIS which basically involve the provision of 2 types of therapeutic intervention CBTp (Cognitive Behavioural Therapy with a psychosis module) and BFT (Behavioural Family Therapy). This is what they will fund so EIS is no longer a needs adaptive model but an IAPT based model and is unable as a service to offer Open Dialogue.
About Author: I am Jane Hetherington Principal Psychotherapist and Operational Lead with Early Intervention Services in Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service, in addition I am on the APOD UK Board and completing the International Train the Trainer Open Dialogue course in Helsinki.